Retrocorneal Membrane After Penetrating Keratoplasty

To report an unusual case of retrocorneal membrane with retropupillary extension after a rejected penetrating keratoplasty. 

Larco Visión, Eye Institute, Quito, Ecuador. 

An 80-year-old female presented to our ophthalmology clinic with decreased visual acuity in her left eye. Past medical history included cataract surgery on both eyes in 2010, followed by penetrating keratoplasty in the right eye later that year. In February 2021, she underwent penetrating keratoplasty in her left eye at another institution due to corneal decompensation. The patient reported partial visual acuity recovery followed by progressive visual loss.

At the initial evaluation, her best corrected visual acuity (BCVA) was logMAR 1.3. On slit-lamp examination, the donor cornea showed edema in all quadrants with loss of transparency, except in the central area where a fixed pupil was unresponsive to light stimuli. The patient's anterior chamber was shallow with the presence of a proliferative membrane that extended over the pupil and to the periphery, which created difficulty to visualize the intraocular lens, and was documented by swept source-optical coherence tomography angiography (SS-OCTA; DRI-OCT Triton Plus, Topcon). 

Seven months later, we performed a second penetrating keratoplasty to remove a fibrous membrane with retropupillary extension using Vannas scissors after the rejected graft was removed. Subsequently, a thinner membrane extending peripherally over the surface of the iris was removed with forceps, simulating a capsulorhexis. No complications were encountered, the postoperative course was uneventful, with a BCVA of logMAR 0.2 after 17 months follow-up.

Retrocorneal membranes after penetrating keratoplasty are uncommon cases that may arise from epithelial ingrowth, inflammatory reactions, or the presence of inadvertent Descemet membrane (DM).